By Prakash Narayan
Published on September 2, 2016
At the outset I should mention that I am a software engineer, far removed from the medical profession. Recently I was at a FinTech (Financial Technology) conference in San Jose, where the panelists were talking about the importance of KYC (Know Your Customer). They were lamenting on how hard it is to get reliable data about customers. Since this conference was packed with backtoback sessions, the only way for the audience to participate was on Twitter – using the hash tag NBSV16. My tweet, “For customer acquisition, I think the panelists are missing a key point: incentives – people are willing to provide data in exchange for them”, resonated well with others (judging from the number of “retweets” and “favorites” that it received).
It was one such incentive that led me to respond to a request from UCSF six years ago to participate in a study on factors leading to heart disease in South Asians. The incentive provided in the email (that called for volunteers to the study) was that they would conduct tests to determine CAC (Coronary Artery Calcium) levels. They went on to say even though monitoring CAC periodically could significantly reduce the risk to heart disease, this is not covered by insurance in normal “Well Care” checks.
I met Alka Kanaya, Professor of Medicine at UCSF, on a beautiful Saturday morning in May 2011 (a weekend was the only time I had available for a 34 hr. appointment). I remember being impressed with how thorough they were in their questionnaire—asking me questions ranging from my food habits, to exercise routine to social life. They even probed my participation in online social networks and my awareness of the physical activities among my friends.
Kanaya completed follow up tests in Nov. 2015—which allowed her to compare against the baseline. In May 2016, she went on a “road show” around the various cities in the Bay Area to present her findings at the conclusion of Phase 1 of her study.
I attended the presentation in the Milpitas library. The study (called MASALA – acronym for Mediators of Atherosclerosis in South Asians Living in America) was funded by the NIH and had a total of 906 participants from the Bay Area and Chicago. The motivation for conducting the study is that while heart disease is the leading cause of death worldwide, South Asians account for greater than half of the world’s cardiac patients. In fact, South Asian immigrants to the United States have higher death rates to heart disease than any other major ethnic group, and we don’t know why. One theory is the “Thrifty gene hypothesis” proposed by James V. Neel, a geneticist, in 1962. According to this, South Asian genes are programmed for famine. So when we switch over to Western-styled diet, the number of calories we consume increases—which, in turn, increases chances of heart ailments. Our ancestors had the perfect solution for maintaining a stable diet – fasts, whether it is for “Ekadashi”, Lent or Ramzan.
Most of us are aware that the major risk factors to heart disease are high cholesterol, high blood pressure, diabetes, smoking, physical inactivity, poor diet, obesity and stress. The father of modern medicine, Hippocrates, said in 400 BC, “Let food be thy medicine, and let medicine be thy food.” We are reminded often that our health is largely in our control. The choices that we make everyday can lead to vibrant health or to a never-ending struggle with diseases and conditions. While we purportedly know all of this, Kanaya’s study attempts to comprehensively understand why South Asians have increased propensity to heart disease and how it can be prevented.
It is not possible to do justice to all the findings from her study in this article. You are encouraged to visit their website http://www.masalastudy.org for more information.
There is sufficient data compiled on Caucasians, African Americans, Latinos and Chinese— with sample sizes in the thousands. This allows for portals that provide a risk assessment of Cardiovascular Disease for people of those ethnicities based on answers to a few simple questions. Dr. Kanaya’s study is a step in this direction for South Asians. Hopefully, at the conclusion of Phase 2 of her study (which has been approved by the NIH), we will have similar engines and risk models for South Asians as well.
One interesting preliminary finding from this study is to understand how social relationships and community involvement affect cardiovascular health. The average network size (defined as people, outside work, that you interact with multiple times a week) for South Asians is 6. Of this, 70% is kin. The conclusion of the study is in the chart. Certainly, exercising with another person is more effective than doing it alone.
The MASALA study has only scratched the surface in helping us understand how South Asians can prevent heart disease.